5500-E 1 Student Records Request Form
- 5000: Student Policies
5500-E 1 Student Records Request Form
_________________________________________
Name of Agency or Individual Requesting Records
________________________________________
Address
I hereby apply to inspect and/or copy the following records (Please be specific).
________________________________________
Reason for request:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________ ___________________________
Signature Representing
___________________________ ___________________________
Mailing Address Date
FOR DISTRICT USE ONLY
APPROVED □
DENIED (FOR REASON[S] CHECKED BELOW)
□ Confidential disclosure □ Unwarranted invasion of personal privacy
□ Part of Investigatory Files □ Record not maintained by the District
□ Record of which the District is legal custodian cannot be found
□ Exempt by status other than the Freedom of Information Act (FOIL)
□ Other (Specify) _____________________________________________
___________________ __________________________ _________________
Signature Title Date
Notice: You have a right to appeal a denial of this application by contacting the Superintendent of Schools.
Approved by the Board of Education: 2/25/10